Evolving Horizons in Temporomandibular Joint Total Replacement: A Comprehensive Narrative Review.

Total temporomandibular joint (TMJ) replacement has become a vital solution for managing end-stage TMJ disorders and significantly enhancing mandibular function and patient quality of life. This narrative review explores the historical developments, clinical objectives, biomaterials, devices, surgical techniques, preoperative preparation, complications, management approaches, and recent innovations in TMJ total joint replacement (TJR). The review draws from a literature search conducted across PubMed, Scopus, Web of Science, and Google Scholar from database inception to August 10, 2025, using terms like "total temporomandibular joint replacement," "TMJ TJR," and "alloplastic TMJ prosthesis," focusing on English-language peer-reviewed articles, reviews, and clinical studies. Current practice leans toward alloplastic reconstruction, utilizing titanium alloys for osseointegration and ultra-high molecular weight polyethylene (UHMWPE) for low-friction surfaces, supported by custom designs via computer-aided design and manufacturing (CAD/CAM). Surgical approaches, including preauricular, retromandibular, and rhytidectomy techniques, have been refined to protect critical structures, such as the facial nerve and internal maxillary artery. Preoperative preparation involves patient education on risks, such as infection and nerve injury; advanced imaging with computed tomography (CT) and 3D reconstructions; and strict aseptic measures. Complications, such as heterotopic bone formation and dislocations, are managed with excision, fat grafting, or surgical redesign, while nerve injuries and synovial issues require targeted interventions. Recent advances have highlighted bioengineered solutions, including bioresorbable composites and nanomaterials, that are promising for merging alloplastic and biological benefits. Currently, these developments, underpinned by ongoing research, position TMJ TJR as a cornerstone of maxillofacial surgery, with the potential to reduce donor morbidity and improve long-term outcomes, although challenges such as infection rates and material hypersensitivity persist, necessitating continued refinement.